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Jakob Dahlberg: Detecting and characterizing thyroid cancer


Thyroid cancer has seen a significant rise. However, the vast majority of thyroid nodules are benign. Jakob Dahlberg’s doctoral project focuses on the optimal identification of tumors requiring treatment. Additionally, it explores new treatment possibilities for advanced thyroid cancer.

Dissertation defense: 12 April 2024 (click for details)
Doctoral thesis: On incidence, diagnostic algorithms and in-depth characterisation of thyroid cancer
Research area: Surgery
Sahlgrenska Academy, The Institute of Clinical Sciences

The incidence of thyroid cancer has sharply increased. The disease typically manifests as a nodule in the thyroid. While the majority of these nodules are benign, just under ten percent are cancerous and necessitate treatment.

“A question arises about how to best investigate patients with symptoms that may indicate cancer. Most thyroid cancer patients are cured through surgery, sometimes supplemented with radioiodine. The challenge is to identify nodules requiring treatment and determine the extent of that treatment,” says Jakob Dahlberg, a researcher at the Institute of Clinical Sciences, and senior physician and endocrine surgeon at Sahlgrenska University Hospital.

Jakob Dahlberg conducts research in surgery at the Institute of Clinical Sciences and is an endocrine surgeon at Sahlgrenska University Hospital.

I have had the opportunity to delve deeper into the aspect of endocrine surgery that I find most interesting

What is your research about?
“It is about detection of thyroid cancer and various aspects of investigating suspected thyroid cancer. The incidence has increased in Sweden and worldwide. The first part of the project focuses on how this rise manifests in Sweden and our region Västra Götaland,” shares Jakob Dahlberg, adding:

“Paper I and II concern the investigation of patients with clinical symptoms suggestive of thyroid cancer, meaning patients referred according to the Standardized Care Pathway (SCP). In Paper IV, we studied patients with advanced thyroid cancer, an area where treatment options are currently limited.”

Causes of the increase unknown

Do we know why there has been a significant rise in thyroid cancer?
“Globally the most common explanation is overdiagnosis, often linked to the intensified use of ultrasound and other diagnostic tools. This leads to the detection of cancers that would not have otherwise caused premature death or even symptoms.”

Does this align with the findings from your research?
“In fact, our study suggests that this situation does not apply to Västra Götaland. There is an increase in thyroid cancer here, but it does not seem to be due to patients being examined without symptoms. We cannot rule out that it is a real increase causing the elevated incidence in Västra Götaland, but we cannot speak to any potential causes.”

Nodules that patients seek medical attention for constitute most of the incidence increase. ‘Incidental’ cases, discovered by microscopic examination after non-cancer-related surgery, also contributed. Symptom-free imaging studies did not contribute.

EU system safe to use

What are your key research findings, and what practical benefits may they provide?
“We have studied the utility of the ultrasound-based risk assessment system EU-TIRADS when investigating whether a thyroid nodule is benign or malignant. We found that using EU-TIRADS can reduce the number of unnecessary fine-needle aspiration biopsies, but the effect is relatively limited. We also found that EU-TIRADS reliably identifies benign thyroid nodules. Therefore, it is safe to use EU-TIRADS when determining which nodules should undergo biopsy and which ones do not need it,” says Jakob Dahlberg.

What did the studies on the challenging advanced thyroid cancer reveal?
“We successfully stimulated the growth of these tumors in immunocompromised mice. This provided us with an opportunity to delve deeper into the characteristics of the tumor. Through mutation analyses, we could identify new potential treatment options.”

Text: Jakob Lundberg